Health in the Global Community.
Women’s health.
Read chapter 15 and 17 of the class textbook and review the attached PowerPoint presentation. Once done, answer the following questions;
1. Describe globalization and international patterns of health and disease.
2. Identify international health care organizations and how they collaborate to improve global nursing and health care.
3. Identify and discuss the major indicators of women’s health.
4. Identify and discuss the barriers to adequate health care for women.
Chapter 15
Health in the Global Community
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
Human health and its influence on every aspect
of life are central to the global agenda.
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
2
Health in the Global Community
Population characteristics
Environmental factors
Patterns of health and disease
International agencies and organizations
International health care delivery systems
The CHN’s role in the global community
Research in international health
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
3
International Community Assessment
Model
Courtesy J. C. Novak.
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
4
Population Characteristics
Large populations create pressures
Goal is to improve quality of life (QOL)
➢
➢
➢
Health promotion
Effective health care delivery systems
Enhancement of the environmental infrastructure
World population distribution is uneven
➢
More than 50% live in China, India, United
States, and Indonesia; 30% are children; 8% are
over 60
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
5
Population Characteristics (Cont.)
Life expectancy varies significantly in
different countries.
➢
Japan 86 years, Zambia 43 years
As the world population grows, a
global trend toward urbanization
occurs.
➢
➢
Live closer together and migrate to
urban areas for employment
Increased living density and global
travel threatens health of general
population by environmental factors
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
6
Environmental Factors
Environmental stressors
➢
Directly assault human health
➢ Damage society’s goods and services
➢ Affect quality of life (QOL)
➢ Interfere with the ecological balance
➢ Natural disasters, terrorism, and war affect all of
the above
The field of environmental health and
sustainable development has exploded since
1990.
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
7
Patterns of Health and Disease
Lifestyles, health and cultural beliefs,
infrastructure, economics, and politics affect
existing illnesses and society’s commitment to
prevention.
Disease patterns vary throughout the world.
Racial, ethnic, and access disparities exist
within and between countries.
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
8
International Organizations
WHO (World Health Organization)
PAHO (Pan American Health Organization)
UN (United Nations)
UNICEF (United Nations International
Children’s Fund)
World Bank
CDC (Centers for Disease Control and
Prevention)
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
9
“Health for All by the Year 2000”
(WHO Goal, 1978)
Goal framed at the Alma-Ata conference in
the Soviet Union in 1978; now extended to
2010 again without attainment
Concept of primary health care
➢
➢
➢
➢
Health as a fundamental human right for
individuals, families, and communities
Unacceptability of the gross inequalities in health
status
Importance of community involvement
Active role for all sectors
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
10
Millennium Development Goals
(United Nations, 2000, 2006)
Target date of 2015
1.
2.
3.
4.
5.
6.
Eradicate extreme hunger and poverty
Achieve universal primary education
Promote gender equality, and empower women
Reduce child mortality
Improve maternal health
Combat HIV/AIDS, malaria, and other infectious
diseases
7. Ensure environmental sustainability
8. Develop global partnerships
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
11
Other Organizations Impacting
International Health
Nongovernmental organizations (NGOs)
➢
➢
Carter Center
Bill and Melinda Gates Foundation
ICN (International Council of Nurses)
HHS (U.S. Department of Health and Human
Services)
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
12
HHS and Healthy People
Serves as a foundation for efforts across the HHS to
create a healthier nation
➢
➢
➢
➢
➢
1979 Surgeon General’s Report, Healthy People: The
Surgeon General’s Report on Health Promotion and Disease
Prevention
Healthy People 1990: Promoting Health/Preventing Disease:
Objectives for the Nation
Healthy People 2000: National Health Promotion and
Disease Prevention Objectives
Healthy People 2010: Objectives for Improving Health
Healthy People 2020: Improving the Health of Americans
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
13
International Health Care Delivery
Systems
Much to learn from one another.
Research and development must be relevant to
infectious diseases that affect the poor.
Need to systematically generate an information base.
Need to consider determinants of health.
Use population-based approaches to address access,
cost, efficiency, and effectiveness.
Collaborate to solve the problems of health care
delivery systems.
Market- and population-based approaches need to
learn from each other.
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
14
International Health Care Delivery
Systems (Cont.)
Effective health care delivery systems must:
➢
Increase access and efficiency.
➢ Improve health status through health promotion
and disease prevention.
➢ Eliminate health disparities.
➢ Protect individuals, families, and communities from
financial loss caused by catastrophic illness.
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
15
Role of the CHN in International
Health Care
Seek to ensure the attainment of health for all in a
cost-effective, efficient, accessible health care
system.
Be involved in research, community assessment,
planning, implementation, management, evaluation,
health services delivery, emergency response, health
policy, and legislation.
Coordinate work with other health care personnel and
community leaders as well as local and global
community leaders.
Utilize changes in the health environment to form the
basis for the nursing role.
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
16
Role of the CHN in International
Health Care (Cont.)
Primary health
care
➢
➢
Essential services
that support a
healthy life.
Involves access,
availability, service
delivery,
community
participation, and
the citizen’s right to
health care.
Primary care
➢
➢
First line or point-ofaccess medical and
nursing care
controlled by
providers and
focused on the
individual.
May not be the
norm as needs of
the group outweigh
the needs of the
individual.
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
17
Role of the CHN in International
Health Care (Cont.)
All nurses in the world must understand
and learn from one another. Nurses are
health care’s most valuable assets.
Community public health nurses can
improve access to care for the most
vulnerable and hard-to-reach groups in
any country.
The future demands evidence-based
learning, engagement, service, and growth
in information technology and local and
global health policy.
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
18
Figure 15-2 Distinction Among Service Programs. Furco, Andrew. “Service-Learning: A Balanced Approach
to Experiential Education.” Expanding Boundaries: Service and Learning. Washington DC: Corporation for
National Service, 1996. 2-6.
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
19
Population-based nursing experts are critical to
solving the challenges of the fragmented,
mismanaged, expensive, ineffective, inefficient
health care delivery system that exists in many
parts of the global community.
– Nies and McEwen (2015)
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
20
Research in International Health
Since 1990, international nursing research has
focused predominantly on:
➢
➢
➢
Student and faculty educational exchange programs
Diverse clinical experiences
The international development of home care or transition
from hospital to home
WHO Collaborating Centers contributed to a
partnership for educational programming, clinical
practice, and research for graduate students in
primary health care nursing and community health
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
21
Chapter 17
Women’s Health
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
Women’s Health
“… essential to the development of health care
for women are the concepts of health
promotion, disease and accident prevention,
education for self-care and responsibility, health
risk identification and coordination for illness
care when needed.”
– Preamble to a New Paradigm for Women’s Health,
Choi (1985)
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
2
Major Indicators of Health
Life expectancy for Americans is at an all-time high.
Mortality rates
➢
➢
➢
➢
Cardiovascular disease (CVD) continues to
be the number one overall killer of women.
Cancer rates are increasing because of
lifestyle choices, environmental
carcinogens, and increase in life
expectancy.
Diabetes mellitus causes the premature
death of many women and is a risk factor
for CVD.
Gaps exist in the availability and quality of
reproductive health care services globally.
From
http://www.nhlbi.nih.gov/educat
ional/hearttruth/
From
http://ndep.nih.gov/partn
ers-communityorganization/campaigns/
SmallStepsBigRewards.
aspx
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
3
Major Indicators of Health (Cont.)
Morbidity rates
➢
More women than men are hospitalized
each year in the United States.
➢ Women are more likely than men to be
disabled from chronic conditions.
➢ Women are more likely than men to have
surgery; many surgeries relate to
reproductive health.
➢ The most frequently occurring
interruption in women’s mental health
relates to depression.
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
4
Social Factors Affecting Women’s
Health
Health care access
Education and work
Employment and wages
Working women and home life
Family configuration and marital status
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
5
Health Promotion Strategies for
Women
Collaboration and an interdisciplinary approach are necessary to
meet the health care needs of women.
Women should receive services that promote health and detect
disease at an early stage.
Many women seek information that will allow them to be in
control of their own health.
Women desire to become more knowledgeable about their own
health.
Health promotion for low-income, underserved women may
differ from that for middle-class women.
Knowledge deficits about one’s own health prevail among
women regardless of socioeconomic or educational level.
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
6
Common Acute Illnesses in Women
Urinary tract infection and dysuria
Diseases of the reproductive tract
➢
Chronic diseases
➢
Vaginitis, vulvovaginitis, pelvic inflammatory
disease (PID), and toxic shock syndrome (TSS)
Coronary vascular disease (CVD) and metabolic
syndrome, hypertension, diabetes, arthritis,
osteoporosis, and cancer (breast, lung,
gynecological)
Mental disorders and stress
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
7
Reproductive Health Concerns
Nutrition
➢
Dysmenorrhea
Family planning
➢
➢
Includes total life nutritional experience
Includes fertility control and infertility
Need multiple safe options designed to meet the
individual needs of all women
STIs, HIV, and AIDS
➢
➢
Women need age-appropriate STI prevention,
education, and counseling.
Worldwide, AIDS is a leading cause of death
among young women.
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
8
Other Issues in Women’s Health
Unintentional injury or accidents
➢
Domestic violence is the single largest cause of
injury to women between the ages of 15 and 44 in
the United States.
Disabilities resulting from acute and chronic
conditions
➢
Women have fewer disabilities than men because
they tend to report their symptoms earlier and
receive necessary treatment.
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
9
Major Legislation Affecting Women’s
Health Services
Public Health Service Act (1982)
➢
Provides biomedical and health services research,
information dissemination, resource development,
technical assistance, and service delivery.
➢ Includes the Family Planning Public Service Act
Title VII of the Civil Rights Act of 1964
➢
➢
➢
Prevents discrimination based on sex, race, color,
religion, or national origin
Amended to also include pregnancy and childbirth
Sexual harassment is violation of Civil Rights Act
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
10
Major Legislation Affecting Women’s
Health Services (Cont.)
Social Security Act
➢
Occupational Safety and Health Act (OSHA)
➢
➢
Provides monthly retirement and disability benefits
to workers and survivor benefits to families
Enacted in 1970
Ensures safe and healthful working conditions
Family and Medical Leave Act (FMLA)
➢
➢
Enacted in 1993
Provides 12 weeks of unpaid leave each year for
family and medical reasons
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
11
Health and Social Services to
Promote the Health of Women
Affordable Care Act (ACA) of 2010
➢
➢
➢
Protection from being denied coverage by
insurance companies
Protection from being charged more for health
care services because of their gender
Preventive care without copays including:
• Well-women visits with screening and counseling for
gestational diabetes, HPV, STIs, HIV, contraception, and
domestic violence
• Breastfeeding counseling support and supplies
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
12
Health and Social Services to Promote
the Health of Women (Cont.)
Medicaid (1965)
➢
➢
➢
➢
A federal- and state-funded health insurance
program for the poor
Expanded under ACA to persons under 65
with an income below 133% of poverty level
Largest source of funding for people with
limited income, regardless of age eligibility
Five broad coverage groups:
• Children, pregnant women, adults in families with
dependent children, individuals with disabilities,
individuals 65 years or older
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
13
Health and Social Services to Promote
the Health of Women (Cont.)
Women’s health services
➢
Provide primary health care needs, as well
as reproductive and maternity care
services including:
• Eating disorders
• All forms of abuse
• Disease prevention, including smoking
cessation
• Health promotion focusing on nutrition,
exercise, and stress management
➢
The National Women’s Health Network is
a strong advocate for women’s concerns.
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
14
Other Community Voluntary Services
Women’s organizations
➢
Networking
➢
Promote voluntary involvement with community;
many others have made women’s health a major
item on their agenda.
Help women advance careers, improve lifestyles,
and increase income and success.
Crisis hotline services
➢
Provide counseling to battered women, battering
parents, rape victims, those considering suicide,
and those with multiple needs.
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
15
Levels of Prevention
Primary prevention
➢
➢
Secondary prevention
➢
Recognize risk for disease and target health
care behaviors to reduce risk
Never smoking, following a nutritious diet, safe
sex practice, avoiding drugs, limiting alcohol
consumption, and staying physically active
Routine screening for cervical cancer, STIs,
breast self-exams, and mammograms
Tertiary prevention
➢
Education and resource utilization
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
16
Roles of the Community Health
Nurse
Direct care
Educator
Counselor
Researcher
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
17
Research in Women’s Health
Research efforts to include women in
studies have grown; not based only on
male subjects
NIH Office of Research on Women’s
Health (ORWH) established in 1990
Many topics examined based on
special task force recommendations
Research on financing and delivery of
health services for women
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
18
Office of Research on Women’s
Health
Overarching themes for research:
➢
Developmental, psychological, spiritual,
and physiological factors effect on
lifespan
➢ Female determinants’ (such as genetics
and gender expectations) effect on health
➢ Health disparities and diversity
➢ Diseases and conditions affecting women
➢ Career development and advancement of
women in the sciences
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
19
“Women are at the center of the health of the
United States; therefore, if better models are
developed for improving the health of women,
the health of the entire nation will benefit.”
– Nies and McEwen (2015)
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